To most, Sunday, April 7, 2019, does not stir up strong emotions or even spark a distant memory. The most popular tweet of the day was “Keep your emotions off the internet” from NFL player JuJu Smith-Schuster; Old Town Road by Lil Nas X jumped 14 spots to No. 1 on the Billboard Hot 100; front page news introduced Candida auris to the public; and in just 24 hours, the Virginia Cavaliers would face the Texas Tech Red Raiders in the NCAA college basketball national championship game. But that day was a big one for Kertisha “Tisha” Brabson and her battle against a relentless disease, because at 5:10 a.m. she opened her eyes and followed simple commands for the first time since she had fallen gravely ill.
A “Strong, Smart, Beautiful” Woman
At 30 years of age, Tisha was living life to the fullest and had a bright future ahead of her in her hometown of Alliance, Ohio. In addition to taking care of her grandmother, she was a single mother to her daughter, Dominique, and son, Perez. Yet while she was a caregiver for others, her loved ones have described her as “super independent,” never asking others for help even when it came to medical bills for her daughter’s battle with sickle cell disease. And in talking with Tisha, it is clear that family is a huge part of her life, whether it be shopping and hanging out with her sisters, cooking soul food for herself and others, traveling to New York, or visiting zoos in Columbus and Cleveland, her fondest memories and hobbies are closely tied to her family.
Her selflessness prevailed not only toward her family, but also in the community, as she decided to help others by obtaining her undergraduate degree in social work. Then, inspired by the beautiful smile she had earned from wearing braces, she decided to pursue a career as a dental assistant at the age of 27. She had also been highly motivated to live a healthy life and had recently lost 40 pounds after setting up a home gym. But little did she know that September 2018 would change her life in a way she had never imagined — and in a way she could no longer remember, as she has no memory of the next seven months that followed her slipping into a coma after a convulsive seizure.
The Relentless Illness
Foreboding changes in Tisha’s actions were first noticed by her mother, Kertease, in the weeks leading up to her initial hospitalization.
“It was as if something had taken over and [was] brewing in my daughter,” Kertease said.
She noticed Tisha was having visual hallucinations and speaking nonsensically, which led to her initial admission at a local hospital on September 7, 2018. Within 10 days, she had been transferred to a tertiary care hospital where she was admitted to a Neurocritical Care Unit (NCCU). Tisha was ultimately diagnosed with anti-NMDA receptor encephalitis, a disease in which the body’s immune system inappropriately attacks a person’s own brain cells.
Although she promptly received medications to suppress her immune system, her clinical course was complicated by ongoing seizures. She was found to have a tumor in her left ovary that was thought to be responsible for her disease, and she underwent a surgery to remove that ovary, along with her fallopian tubes. Forty-six days after being admitted to the tertiary care hospital, she was finally discharged to a long-term acute care hospital (LTACH), still requiring life support with breathing and feeding tubes. Despite the prompt diagnosis and appropriate treatment, she remained comatose and was still very much in the midst of an internal battle for her life. Little did anyone know that a long and arduous journey remained ahead of her.
Thirty-four days after being discharged to the LTACH, Tisha was brought back to the local community hospital because her seizures had recurred and again became relentless. Over the next few days, her seizures continued in the face of aggressive treatment, except they had now transformed into a condition called non-convulsive status epilepticus where the seizures manifested primarily as highly abnormal brainwave activity while overt clinical symptoms were more subtle. Because her condition had proven so difficult to treat, she was transferred to The Ohio State University Wexner Medical Center (OSUWMC) 10 days later for more specialized care.
Upon transfer, she received additional treatment to suppress her immune system that was guided by the level of antibodies in her cerebrospinal fluid. Throughout much of her stay in the NCCU at OSUWMC, she remained on multiple concurrent anesthetic infusions to control her seizures, along with a host of other anti-seizure medications that she would continue longer-term. In the 122 days that followed, the neurocritical care team at OSUWMC persevered in her care, in collaboration with many other multidisciplinary teams.
There were epileptologists and neuroimmunologists, who helped determine the best plan for Tisha’s anti-seizure and immunosuppressive medications. Neurocritical care phamacists were also heavily involved in guiding the adjustment of these medications based on how Tisha’s body was metabolizing them. Then there were respiratory therapists who provided ventilator support and helped obtain studies that tested Tisha’s metabolism and nutritional requirements, plus dieticians who adjusted her nutrition to meet her metabolic demands (including purposefully inducing ketosis, which helped the medical team treat Tisha’s seizures). Additionally, teams from gynecology, neurosurgery and psychiatry were also deeply invested in her care. And perhaps above all was the meticulous and dedicated care that Tisha’s nurses provided her every day. All of this interdisciplinary team effort eventually paid off when Tisha finally woke up from her prolonged coma on April 7, 2019.
The Road to Recovery
Tisha remembers “waking up to a dark room … alone.” She reports having “absolutely no memory of [my] sickness during [my] coma state,” and her last memory was from seven months prior to her illness. Fall had turned to winter, and winter to spring. Her 30th birthday had come and gone. Her children “had to learn to live without her” and life as she knew it had changed.
While waking up was a monumental hurdle to overcome in her path to recovery, she still had a long road ahead of her. Her recovery process included extensive physical therapy, occupational therapy and speech therapy at OSUWMC, followed by a lengthy stay at an acute rehabilitation facility. After finally being discharged home, she moved in with her mother and her mother’s husband, Larry, who have since cared for her and her two children. Once at home, Tisha was initially plagued by intense mood swings and “low times,” but over time these have gradually improved. Her family understands this as being part of her recovery process and are happy to see her progress, though they eagerly await the return of the calm, controlled and fearless woman they’ve always known.
It has been nine months since Tisha first woke up from her coma. She says she is now able to function mostly independently but still requires some help from her family at times, especially with her kids. She often cooks dinner for her family and is using this time to regain her bond with her young children, who had had to learn to live without their mother for so many months. She says she still feels the need to sleep a lot, but the disturbing nightmares she once experienced on a regular basis after waking up have gradually faded. Although it has been a tremendous blessing to be alive and to make such a remarkable recovery, she reports it has been a struggle to get her life back, especially her relationship with her children. After returning home, Dominique and Perez seemed distant, which was heartbreaking for Tisha. Slowly, though, they are finally beginning to get used to her again with time. But there are still many other struggles that she encounters on a daily basis, all while she tries to coordinate all her doctors’ appointments and take her medications while finding a way to resume a normal life.
Her mother says that “everybody is interested in her story and thinks how wonderful things must be now, but no one truly understands the aftermath and daily hardships of a coma survivor.” Regardless of the mounting bills and daily struggles in keeping their lives together, Tisha and her family feel very fortunate and are extremely grateful to have the support of their community in Alliance; their family and friends have shown the utmost support and have “chipped in” where needed. Tisha understands that “time is the biggest healer” and is thrilled to be alive. She is intent on maintaining a positive mindset and is planning on going back to work imminently as a part-time dental assistant.
From Kertisha “Tisha”: I would like to thank my mother, her husband Larry, my grandmother, my older sister RaQueal, my cousins Tina and Lynn, and the community of Alliance, Ohio, for their incredible support throughout my disease and recovery. I owe my life to doctors at The Ohio State University Wexner Medical Center and would like to thank all of them for helping me.
From The Ohio State University Wexner Medical Center: We would like to thank Kertisha “Tisha” for allowing us to share her story of hope, which provides us all with the hope of curing those in the face of unsurmountable odds, and her mother Kertease for discussing her experience during this time in their lives. Additionally, we would like to acknowledge the entire staff who cared for Tisha in the NCCU at The Ohio State University Wexner Medical Center. It truly takes a village to care for those who can’t care for themselves.